title: Clinical-guide risk prediction of hepatocellular carcinoma development in chronic hepatitis C patients after interferon-based therapy.
abstract: BACKGROUND
  Interferon (IFN)-based therapies could eradicate hepatitis C (HCV) and reduce the risk of hepatocellular carcinoma (HCC). However, HCC could still happen after sustained virological response (SVR). We aimed to develop a simple scoring system to predict the risk of HCC development among HCV patients after antiviral therapies.
  
  
  METHODS
  From 1999 to 2009, 1879 patients with biopsy-proven HCV infection treated with IFN-based therapies were analyzed.
  
  
  RESULTS
  Multivariable analysis showed old age (adjusted HR (aHR)=1.73, 95% CI=1.13-2.65 for aged 60-69 and aHR=2.20, 95% CI=1.43-3.37 for aged ≥ 70), Male gender (aHR=1.74, 95% CI=1.26-2.41), platelet count <150 × 10(9)/l (HR=1.91, 95% CI=1.27-2.86), α-fetoprotein ≥ 20 ng ml(-1) (HR=2.23, 95% CI=1.58-3.14), high fibrotic stage (HR=3.32, 95% CI=2.10-5.22), HCV genotype 1b (HR=1.53, 95% CI=1.10-2.14), and non SVR (HR=2.40, 95% CI=1.70-3.38) were independent risk factors for HCC. Regression coefficients were used to build up a risk score and the accuracy was evaluated by using the area under the receiver operating characteristic curve (AUC). Three groups as low-, intermediate-, and high-risk are classified based on the risk scores. One hundred sixty patients (12.78%) in the derivation and 82 patients (13.08%) in the validation cohort developed HCC with AUC of 79.4%, sensitivity of 84.38%, and specificity of 60.66%. In the validation cohort, the 5-year HCC incidence was 1.81%, 12.92%, and 29.95% in low-, intermediate-, and high-risk groups, with hazard ratios 4.49 in intermediate- and 16.14 in high-risk group respectively. The risk reduction of HCC is greatest in patients with SVR, with a 5-year and 10-year risk reduction of 28.91% and 27.99% respectively.
  
  
  CONCLUSIONS
  The risk scoring system is accurate in predicting HCC development for HCV patients after antiviral therapies.
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: K-C
authors.initials: KC
authors.lastname: Chang
authors.forename: Y-Y
authors.initials: YY
authors.lastname: Wu
authors.forename: C-H
authors.initials: CH
authors.lastname: Hung
authors.forename: S-N
authors.initials: SN
authors.lastname: Lu
authors.forename: C-M
authors.initials: CM
authors.lastname: Lee
authors.forename: K-W
authors.initials: KW
authors.lastname: Chiu
authors.forename: M-C
authors.initials: MC
authors.lastname: Tsai
authors.forename: P-L
authors.initials: PL
authors.lastname: Tseng
authors.forename: C-M
authors.initials: CM
authors.lastname: Huang
authors.forename: C-L
authors.initials: CL
authors.lastname: Cho
authors.forename: H-H
authors.initials: HH
authors.lastname: Chen
authors.forename: T-H
authors.initials: TH
authors.lastname: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000821:virology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007372:Interferons / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012306:Risk; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D007372:Interferons